Laparoscopic Anatomic Resection Guided by Indocyanine Green Fluorescence Imaging - A Single Institution Experience -

Abstract

In laparoscopic anatomic resection, especially in the sub-segmentectomy of segment 8 or 7, it can be difficult to detect and dissect the targeted branch of Glisson sheath from the hepatic hilum. When that is the case, we inject dye into the targeted portal vein to stain the resection area by using an ultrasound-guided vascular access system for laparoscopic surgery. We use the Bk5000/9066 (BK medical) ultrasound machine with a built-in probe for ultrasound-guided vascular access. This system has an advanced laparoscopic ultrasound transducer that has a small hole for the needle on the tip of the probe which can draw a guideline for the needle. We also use the laparoscope Indocyanine Green (ICG) fluorescence imaging camera system (Storz). The dye is a mixture of ICG and Indigo carmine. Under guidance of ultrasonography, we detect the targeted portal vein and percutaneously insert the PTCD needle into the portal vein. Then, we slowly inject the dye observing the dyeing process with the ICG imaging camera. By using ICG together with Indigo carmine we can detect the color contrast between the area to be resected and the rest of the liver more precisely, especially when we cannot get a clear border line with Indigo carmine for whatever reason. The US-guided injecting ICG together with Indigo carmine into the targeted portal vein can draw a demarcation line more efficiently and clearly than was previously possible. This system should be useful, especially in the laparoscopic anatomic resection of the sub-segment or a smaller area.